[Microfracture for treatment of cartilage detects].

Abstract

Subchondral bone plate microfracture technique (Steadman) has shown to enhance chondral resurfacing by providing a suitable environment for tissue regeneration and taking advantage of the body's own healing potential. Microfracture technique belongs to the bone marrow stimulating methods like abrasion arthroplasty or subchondral bone drilling. Using a specially designed awl or pick, multiple perforations ("microfractures") are placed 3 to 4 mm apart and about 4 mm deep into the subchondral bone to reach a zone of vascularization. The formation of a fibrin clot ("super clot") containing the desired pluripotential stem cells is stimulated. This clot then differentiates and remodels, resulting in a durable fibrocartilage repair tissue. The arthroscopic awls produce essentially no thermal necrosis of the bone compared to hand-driven or motorized drills. In contrary to drills, it is possible with differently curved awls to reach and treat every area of the knee joint or even of the upper ankle or shoulder joint. Between 1992 and 1998 this technique has been used in 351 cases. 162 patients were interviewed with a questionnaire with respect to their subjective judgement of health between 3 and 6 years (mean 4.4) after operation. Pain was the parameter with the greatest improvement. 78% of the patients improved, 18% remained unchanged and 4% were worse. Microfracture is an advisable option for the treatment of full thickness chondral defects.